Post-Payment Services

As national healthcare spending continues to outpace economic growth, healthcare payers are challenged to find innovative ways to manage and contain costs wherever possible. Viant offers its customers a variety of out-of-network cost containment solutions to accurately identify and recover overpayments through its Post-Payment Services.

Capabilities
Viant’s Post-Payment Services offering is designed to pinpoint and reduce billing and coding errors, cost-shifting practices and fraud and abuse after medical claims have been paid. Viant has developed the specific audit expertise, analytical tools and effective protocols for reducing a payer’s costs on already paid, out-of-network claims.

Hospital Bill Audit Services
Hospital Bill Audit Services (HBA) is a post-payment tool that can audit medical claims before or after they are paid. The analysis compares physician treatment orders to billed charges. Hospital bill audits usually occur on-site at the facility and the results are confirmed with a signed agreement.

HBA ensures that claims payments are made only for services actually rendered through a complete and reliable verification of bill accuracy:

• Effective post-payment cost control for large facility bills with minimum repercussions
• Discount rates range from 3% to 10%, with average savings approximately $2,500 per claim
• Ability to audit hospital bills before or after the claim is paid
• Signed agreement with provider on each claim; minimal appeals and back-end “noise”

DRG Validation Services
Viant’s DRG Validation Services (DRG) ensures that the diagnosis and procedure codes that generate the diagnosis related groups, and therefore, the hospital invoice, are accurate, valid and sequenced in accordance with national coding standards.

Viant’s DRG Validation Services offering is a "must" if reimbursement terms with providers are based on a DRG assignment:

• Effective post-payment cost control for large facility bills with minimum repercussions
• The average discount rate on successful claims is more than 45%, equating to an average dollar savings of approximately $5,000 per claim
• Signed agreement with provider on each claim; minimal provider appeals and back-end “noise”
• Reviews are customized and targeted based on the DRG-related terms of clients’ contracts

Contract Compliance Audit Services
Contract Compliance Audit Services (CCA) is an intensive audit review that looks at paid home infusion, durable medical equipment and renal (dialysis) claims. CCA identifies the overdelivery of products, services or overpayments due to misapplied or misinterpreted contract terms. CCA reconciles claims not only based on the correct contractual reimbursement, but often savings are realized by our ability to verify and reconcile the actual physician order, versus what was billed on the claim.

Viant’s CCA results offer organizations a comprehensive and detailed understanding of the "root cause" of overpayments and help clients develop significant process improvements of their own:

• Specialized cost containment for unregulated high-cost specialty services such as home infusion and durable medical equipment, with high potential for savings
• Depending on service mix, savings average 45%, and equate to approximately $1,200 per claim
• CCA results can be used to improve and strengthen future specialty contracts with providers
• Additional filter to maximize post-payment savings recovery in addition to traditional hospital bill audit or DRG validation services

RxI Services
Healthcare payers now can control the rising costs associated with reimbursement of prescription injectable medications in physician and other outpatient settings through Viant’s RxI Services. This unique service helps manage high-cost injectable and specialty pharmaceuticals administered in care settings such as oncology, physician, home infusion and renal dialysis.

Viant’s RxI Services provides the most comprehensive review to validate the clinical, contractual and financial components of a claim:

• Specialized clinical expertise and familiarity with dosing, package and pharmaceutical calculations
• Proprietary technology to screen high volumes of claims and check for clinical appropriateness of dosage and quantity of drug billed relative to days supply
• Verification of actual physician’s order, validating drug, dosage, frequency and length of therapy if necessary
• Facilitates contract and fee schedule language enhancements to address potential overbilling of units

Overpayment Recovery Services
In conjunction with its validation and audit services, Viant offers customers the added benefit of its Overpayment Recovery Services. This option helps Viant's customers realize the true value of medical cost savings identified through HBA or DRG Validation Services through the actual recovery of claims overpayments. Viant's Overpayment Recovery Services has the refund recovery preparation and collections expertise to consistently recoup claim overpayments with low provider appeals.

Summary
As a result of escalating healthcare costs, it has become necessary for payers to employ novel approaches to achieve cost savings. Viant’s Post-Payment Services suite utilizes proprietary tools to identify billing errors that can often result in overpayments to providers. Armed with this information, payers have the opportunity to recoup costs after claims have been paid. To learn more about Viant’s Post-Payment Bill Management Services, call us today at 800.820.5824.